Cytomegalovirus reactivation following hematopoietic stem cell transplantation

Abstract

Introduction: There is a high prevalence of cytomegalovirus (CMV) seropositivity in developing countries. An apparent risk of CMV reactivation increases following hematopoeitic stem cell transplantation. With effective surveillance and timely treatment using anti-viral therapy, morbidity and mortality associated with CMV reactivation can be reduced. Objectives: To evaluate the incidence and morbidity associated with CMV reactivation following hematopoeitic stem cell transplantation. Methodology: We retrospectively analysed 136 hematopoeitic stem cell transplant recipients at our centre for CMV reactivation and their complications. Quantification of CMV-DNA was done by PCR. CMV disease was confirmed histologically via CMV inclusion bodies or immunostaining of biopsy of the affected organ, mainly the gastrointestinal tract. Results: A total of 13 out of 136 patients (9.56%) had CMV reactivation. 6 out of 13 patients had CMV disease, 3 of which died (23.1% of patients with CMV reactivation). CMV reactivation occurred at a median duration of 52.5 days post transplantation (range 35-178 days). The gastrointestinal tract was the organ most commonly affected by CMV. The median follow-up was 14 months (range 6 -64 months). Conclusion: Through a higher rate of sero-prevalance in developing countries, the incidence of CMV infection following hematopoeitic stem cell transplantation is comparable to that reported in Western literature. Oral valganciclovir was an effective pre-emptive therapy for CMV disease.

Cost of Hematopoietic Stem Cell Transplantation in India

“…These are a) infections (bacterial, fungal and viral), b) requirement of blood product transfusions, particularly because of the delay in platelet engraftment- requiring irradiated single donor platelets, c) Intensive care- patients requiring admission in medical intensive care units or ventilator support, d) onset of severe acute GvHD. Also, various infective and non-infective complications can develop later on, following the discharge from the hospital, and can increase the total cost of stem cell transplantation 13–15…”

Detection of human cytomegalovirus (CMV) DNA in feces has limited value in predicting CMV enteritis in patients with intestinal graft‐versus‐host disease after allogeneic stem cell transplantation

“…Cytomegalovirus (CMV) infection and disease remain a major complication after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) . Despite the improvement in treatment options, CMV‐related complications are still important causes of treatment‐related mortality .…”

A Low Incidence of Cytomegalo Virus Infection Following Allogeneic Hematopoietic Stem Cell Transplantation Despite a High Seroprevalence

“…The incidence of CMV reactivation post SCT is comparatively less in reports from Asian countries, as in a report from Korea which reported a lower incidence of CMV infection (42.2%) despite a higher seroprevalence in the recipients and donors [13]. An earlier report from India, had reported even less incidence (9.5%) of CMV infection at a median of 52 days in the post allogeneic stem cell transplant setting [15].…”